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FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Alcohol Use and Alcohol Use and PregnancyPregnancy
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Age & Drinking During Age & Drinking During PregnancyPregnancy
11.714.1
16.4
22.6
0
5
10
15
20
25
-25 25-29 30-34 35+
Percentage Womenwho drank duringpregnancy, 1996-97
Age
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Awareness in CanadaAwareness in Canada Health Canada Study released January 2000Health Canada Study released January 2000
High level of knowledge re: alcohol use in High level of knowledge re: alcohol use in pregnancy can lead to life long problems (89%)pregnancy can lead to life long problems (89%)
Most women said they would stop or cut back if Most women said they would stop or cut back if pregnant (73%), only 4% said they would not pregnant (73%), only 4% said they would not changechange
Confusion on when to stop drinking, safe Confusion on when to stop drinking, safe drinking levels and characteristics of drinking levels and characteristics of
FASDFASD
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Adolescent Girls and Young Adolescent Girls and Young Women: Alcohol Use and Women: Alcohol Use and
PregnancyPregnancy Survey found 22% of girls in grade Survey found 22% of girls in grade
10, 12% in grade 8, and 2% in grade 10, 12% in grade 8, and 2% in grade 6 reported drinking an alcoholic 6 reported drinking an alcoholic beverage once a week or morebeverage once a week or more
Research indicates that girls out of Research indicates that girls out of the mainstream have higher rates of the mainstream have higher rates of alcohol use and riskier patterns of alcohol use and riskier patterns of useuse
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Adolescent Girls and Young Adolescent Girls and Young Women: Alcohol Use and Women: Alcohol Use and
PregnancyPregnancy Studies have shown that young Studies have shown that young
people are more likely to engage in people are more likely to engage in sex without the use of contraception sex without the use of contraception when they are drinkingwhen they are drinking
Some indication that young women Some indication that young women identify their pregnancy later in term identify their pregnancy later in term than older womenthan older women
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Why do some women use Why do some women use alcohol while pregnant?alcohol while pregnant?
Many women don’t plan to get pregnantMany women don’t plan to get pregnant Some women are unaware of, Some women are unaware of,
misinformed, about the consequences of misinformed, about the consequences of alcohol’s effect on the developing fetusalcohol’s effect on the developing fetus
Most will want to reduce or stop alcohol Most will want to reduce or stop alcohol use when they find out they are pregnantuse when they find out they are pregnant
Women who are addicted may not be able Women who are addicted may not be able to stop drinkingto stop drinking
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Those Who Keep Those Who Keep DrinkingDrinking
AddictionAddiction Social acceptanceSocial acceptance Family/peer/professional pressureFamily/peer/professional pressure Cope with painful feelings or stressful Cope with painful feelings or stressful
eventsevents Self medicate a mental health condition Self medicate a mental health condition
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Barriers to Seeking Barriers to Seeking SupportSupport
Denial of drinking problemDenial of drinking problem Guilt and shameGuilt and shame Fear of losing childrenFear of losing children Childcare, finances, loss of homeChildcare, finances, loss of home Opposition from family & friendsOpposition from family & friends Stigma associated with alcohol use Stigma associated with alcohol use
during pregnancy and FASDduring pregnancy and FASD
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Prevention Efforts Prevention Efforts Must…Must…
……move the focus from women’s move the focus from women’s alcohol use to an increased alcohol use to an increased understanding of related health and understanding of related health and social problems that contribute to social problems that contribute to FASD.FASD.
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Determinants of HealthDeterminants of Health
Income and social Income and social statusstatus
Social support Social support networksnetworks
EducationEducation Employment and Employment and
working conditionsworking conditions Social environmentsSocial environments Physical environmentPhysical environment GenderGender
CultureCulture Personal health Personal health
practices and coping practices and coping skillsskills
Healthy child Healthy child developmentdevelopment
Health servicesHealth services Biology and genetic Biology and genetic
endowmentendowment
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Our responsibility is to …Our responsibility is to …
……provide a network of supports provide a network of supports that directly address these that directly address these contributing factorscontributing factors
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Key MessagesKey Messages
Drinking alcohol during pregnancy Drinking alcohol during pregnancy can cause birth defectscan cause birth defects
There are no known safe limitsThere are no known safe limits It is best to plan ahead and to stop It is best to plan ahead and to stop
drinking before you get pregnantdrinking before you get pregnant It is never too late to stop drinkingIt is never too late to stop drinking
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Don’t Forget ….Don’t Forget ….
Emphasize the importance of the health Emphasize the importance of the health of both the woman and the fetus/childof both the woman and the fetus/child
Be sensitive to physical/sexual trauma Be sensitive to physical/sexual trauma (past and present)(past and present)
Address family issues and offer support Address family issues and offer support to family members, whenever possibleto family members, whenever possible
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Alcohol Risk AssessmentAlcohol Risk Assessment
No risk Low Risk Moderate Risk High Risk
Problems have not developed Problems have developed
Risk Reduction
Early Intervention
Treatment/Intervention
Health Enhancement
Risk Avoidance
70% of women who drink will avoid alcohol during their pregnancy if they understand it will cause
damage to the developing fetus
20% of women will require support of
their partner, family and friends to avoid
alcohol
10% of women will require specific intervention to reduce and/or
eliminate alcohol (harm reduction)
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Screening ToolsScreening Tools
Brief alcohol screening questionnaires Brief alcohol screening questionnaires developed to detect periconception risk-developed to detect periconception risk-drinking associated with adverse pregnancy drinking associated with adverse pregnancy outcomes (defined as two or more drinks per outcomes (defined as two or more drinks per day)day)
Tools assess alcohol intake indirectly by Tools assess alcohol intake indirectly by asking about tolerance to alcohol’s effects, asking about tolerance to alcohol’s effects, i.e., psychological consequences and i.e., psychological consequences and significant other’s concernssignificant other’s concerns
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
T-ACET-ACE How many drinks does it take to make you How many drinks does it take to make you
feel high? (feel high? (Score 2 for 3 or more drinks)Score 2 for 3 or more drinks) Have people annoyed you by criticizing Have people annoyed you by criticizing
your drinking? (your drinking? (Score 1 for yes)Score 1 for yes) Have you ever felt you ought to cut down Have you ever felt you ought to cut down
your drinking? (your drinking? (Score 1 for yes)Score 1 for yes) Have you ever had a drink in the morning Have you ever had a drink in the morning
to steady your nerves or get rid of a to steady your nerves or get rid of a hang over? (hang over? (Score 1 for yes)Score 1 for yes)
Score of 2 or more = high risk, 0 or 1 = low riskScore of 2 or more = high risk, 0 or 1 = low risk
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
TWEAKTWEAK
Tolerance (number of drinks)Tolerance (number of drinks) Worry about drinking (has anyone Worry about drinking (has anyone
worried about your drinking in the worried about your drinking in the past year?)past year?)
Eye-openersEye-openers Amnesia (blackouts)Amnesia (blackouts) Cut down on alcoholCut down on alcohol
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Stages of ChangeStages of Change
Pre-contemplation – not thinking Pre-contemplation – not thinking about quittingabout quitting
Contemplation – thinking about Contemplation – thinking about quittingquitting
Preparation – getting ready to quitPreparation – getting ready to quit Action – process of quittingAction – process of quitting Maintenance – staying substance freeMaintenance – staying substance free
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Increasing Awareness Increasing Awareness
Provide informationProvide information Marriage preparation classes Marriage preparation classes Preconception classesPreconception classes Pregnancy support programsPregnancy support programs Keep up-to-date on informationKeep up-to-date on information Make referrals to well informed Make referrals to well informed
resourcesresources Ask what would be helpfulAsk what would be helpful
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Fathers-to-beFathers-to-be
Clarify that their drinking cannot cause Clarify that their drinking cannot cause FASD, but can lead to infertility and less FASD, but can lead to infertility and less viable spermviable sperm
Important role in supporting partner Important role in supporting partner through pregnancythrough pregnancy
Their behavior can help a partner Their behavior can help a partner stop drinkingstop drinking
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
Things to Keep in MindThings to Keep in Mind
There are no known safe limits and no safe time There are no known safe limits and no safe time to drink during pregnancyto drink during pregnancy
Raise awareness without raising panicRaise awareness without raising panic
Information is not enoughInformation is not enough
Promote the benefits of a planned pregnancyPromote the benefits of a planned pregnancy
Working on prevention can raise community Working on prevention can raise community interest in support for those with FASDinterest in support for those with FASD
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
ResourcesResources
Keys to a Successful Alcohol and Keys to a Successful Alcohol and Pregnancy Campaign, Pregnancy Campaign, www.beststart.org/resources/alc_reductiowww.beststart.org/resources/alc_reduction/index.htmln/index.html
Alberta Alcohol and Drug Abuse Alberta Alcohol and Drug Abuse CommissionCommission
www.aadac.comwww.aadac.com
FASEout Project 2006 www.faseoFASEout Project 2006 www.faseout.caut.ca
ResourcesResources
[email protected]@utoronto.ca “ “Father Involvement and FASD: Father Involvement and FASD: Developing Best Practices,” Developing Best Practices,” 2005.2005.
Rutman, D., Callahan, M., Lundquist, A., Jackson, S., Field, B. Rutman, D., Callahan, M., Lundquist, A., Jackson, S., Field, B. Substance Use and Pregnancy: Conceiving Women in the Substance Use and Pregnancy: Conceiving Women in the Policy-Making ProcessPolicy-Making Process. Status of Women, Canada, August . Status of Women, Canada, August 2000. 2000.
British Columbia Reproductive Care Program. British Columbia Reproductive Care Program. BCRCP BCRCP Guidelines for Alcohol Use in the Perinatal Period and Fetal Guidelines for Alcohol Use in the Perinatal Period and Fetal Alcohol Spectrum DisorderAlcohol Spectrum Disorder. 2005. www.rcp.gov.bc.ca. 2005. www.rcp.gov.bc.ca
Leslie, M., Reynolds, W.Leslie, M., Reynolds, W. The Smart Guide: Motivational The Smart Guide: Motivational Approaches Within the Stages of Change for Pregnant Women Approaches Within the Stages of Change for Pregnant Women Who Use Alcohol: A Training Manual for Service ProvidersWho Use Alcohol: A Training Manual for Service Providers , , March 2002March 2002